Variation In The Effectiveness Of Collaborative Care For Depression: Does It Matter Where You Get Your Care?

Unützer, Jürgen; Carlo, Andrew D.; Arao, Robert F.; Vredevoogd, Melinda; Fortney, John C.; Powers, Diane; Russo, Joan

doi:10.1377/hlthaff.2019.01714

Cited by 23 publications

(24 citation statements)

References 22 publications

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“…28 A high level of variation in clinical outcomes across sites that implement CoCM has been found. 25 We have extended this work by showing that two OSC dimensions (pro cient culture and functional climate) are associated with variation in clinical outcomes of patients independent of other factors known to be associated with this variation. .…”

Section: Discussionmentioning

confidence: 76%

“…As is shown in Table 1, the sample was comprised of women (mean age = 33 years) of diverse race/ethnicity. The mean and range of initial depression symptomatology level (mean = 16.2, SD = 4.69; range = 10-27), included patients in the moderate (PHQ-9 score of [15][16][17][18][19] and severe (20)(21)(22)(23)(24)(25)(26)(27) range; a high percentage of women reported suicidal ideation (28.2%). There were signi cant differences among the 10 participating health centers on patients' mean age at baseline, proportion of patients of Latina ethnicity, proportion of patients of Black/African American race, and proportion of patients with a history of prior treatment (P<.05); all of these were included as control variables in the analyses to adjust for differences in case mix.…”

Section: Resultsmentioning

confidence: 99%

“…An assessment of health center culture and climate was associate with this variation in patients' improvement in clinical depression from baseline to 6.5 months post-baseline independent of other factors known to be associated with this variation including level of implementation support. 25 Speci cally, at 6.5-months post-baseline, patients who received the CoCM in primary care health centers with highly pro cient cultures improved in their depression symptoms on average by 5.08 points compared to an average improvement of only 0.14 points among patients served by centers with less pro cient cultures. This resulted in a large adjusted effect size of d = 0.78.…”

Section: Discussionmentioning

confidence: 99%

“…14,22,23 Moreover, the success of CoCM implementation and sustainment for general adult populations, measured by delity and clinical patient bene t, is highly variable. 24,25 The identi cation of tools and strategies which can increase the rate of effective implementation of this evidence-based model for depression in primary care settings has high potential to improve population behavioral health.…”

Section: Introductionmentioning

confidence: 99%

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Association of Organizational Culture and Climate With Variation in the Clinical Outcomes of Collaborative Care for Maternal Depression in Community Health Centers

Williams

Russo

Vredevoogd

et al. 2021

Preprint

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BackgroundOrganizational culture and climate may help explain variation in the effectiveness of evidence-based practices implemented in primary care settings; however, this hypothesis has not been well tested. This study tested the relationship between organizational culture and climate and variation in clinical outcomes of the evidence-based collaborative care model (CoCM) for maternal depression implemented in primary care health centers serving low income populations.MethodsOrganizational cultures and climates of ten community health centers providing collaborative care for depression among women in pregnancy and parenting were assessed using the Organizational Social Context (OSC) measure. Three-level hierarchical linear models tested whether variation in culture and climate predicted variation in improvement in depression symptoms from baseline to 6.5 months post-baseline for N=468 women who initiated care in the year before and after the OSC assessment. Depression symptomology was measured using the Patient Health Questionnaire (PHQ-9).ResultsAfter controlling for patient characteristics, case mix, center size, and implementation support, patients served by health centers with more proficient cultures improved significantly more from baseline to 6.5 months post-baseline than patients served by centers with less proficient cultures (mean improvement = 5.08 vs. 0.14, respectively, P<.05), resulting in a large adjusted effect size of dadj = 0.78. A similar effect was observed for patients served by centers with more functional climates (mean improvement = 5.25 vs. 1.12, P<.05, dadj = 0.65). Growth models indicated that, on average, patients served by centers with more proficient cultures recovered after four months of care and remained stabilized below the clinical cutoff at 6.5 months post-baseline, whereas patients served by centers with less proficient cultures improved after four months but then deteriorated to above the clinical cutoff by 6.5 months post-baseline (P<0.05). A similar pattern was observed for functional climate.ConclusionsVariation in clinical outcomes for women from vulnerable populations receiving collaborative care for maternal depression was associated with the organizational cultures and climates of primary care health centers. Implementation strategies that target proficient culture and functional climate may improve the implementation and effectiveness of integrated behavioral health care for depression by reducing this variation.

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Section: Discussionmentioning

confidence: 76%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Association of Organizational Culture and Climate With Variation in the Clinical Outcomes of Collaborative Care for Maternal Depression in Community Health Centers

Williams

Russo

Vredevoogd

et al. 2021

Preprint

Self Cite

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“…more successful outcomes. 27 Whether current strategies for doing this would succeed or be sustainable is unclear.…”

Section: Figurementioning

confidence: 99%

The Potential for Improving the Population Health Effectiveness of Screening: A Simulation Study

2021

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BACKGROUND AND OBJECTIVES: Screening interventions in pediatric primary care often have limited effects on patients' health. Using simulation, we examined what conditions must hold for screening to improve population health outcomes, using screening for depression in adolescence as an example.METHODS: Through simulation, we varied parameters describing the working recognition and treatment of depression in primary care. The outcome measure was the effect of universal screening on adolescent population mental health, expressed as a percentage of the maximum possible effect. Through simulations, we randomly selected parameter values from the ranges of possible values identified from studies of care delivery in real-world pediatric settings. RESULTS:We examined the comparative effectiveness of universal screening over assessment as usual in 10 000 simulations. Screening achieved a median of 4.2% of the possible improvement in population mental health (average: 4.8%). Screening had more impact on population health with a higher sensitivity of the screen, lower false-positive rate, higher percentage screened, and higher probability of treatment, given the recognition of depression. However, even at the best levels of each of these parameters, screening usually achieved <10% of the possible effect. CONCLUSIONS:The many points at which the mental health care delivery process breaks down limit the population health effects of universal screening in primary care. Screening should be evaluated in the context of a realistic model of health care system functioning. We need to identify health care system structures and processes that strengthen the population effectiveness of screening or consider alternate solutions outside of primary care.

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Assessment of Perceptions of Mental Health vs Medical Health Plan Networks Among US Adults With Private Insurance

Busch

Kyanko

2021

JAMA Netw Open

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IMPORTANCE Ten years after the Mental Health Parity and Addiction Equity Act, patients continue to report insurance-related barriers to specialty mental health care.OBJECTIVES To assess privately insured patients' perceptions of the adequacy of their health plan's provider network (provider network includes physicians, clinicians, other health care professionals, and their institutions that constitute the network), whether practitioners frequently leave plans, and whether practitioner plan participation affected patients' plan choice. DESIGN, SETTING, AND PARTICIPANTSA nationally representative, population-based internet survey study of English-speaking US adults participating in KnowledgePanel, an online research panel, was conducted from August to September 2018. Data analysis was performed from November 12, 2020, to May 12, 2021. From a sample of 29 854 panelists aged 18 to 64 years, 19 602 initiated the screener (completion rate of 66%), and 728 met study criteria: adults with private insurance receiving both specialty mental health and medical care in the past year.EXPOSURE Health plan's provider network. MAIN OUTCOMES AND MEASURESSelf-report of plan inadequacy, whether a practitioner left the plan and the participant's responses (stopped treatment, switched practitioner, or continued treatment), and whether participation of a specific practitioner was considered when a health plan was chosen. Experiences with both mental health and medical provider networks were assessed.Analyses were weighted to match the sample to the US population. Weights provided by KnowledgePanel were also adjusted for panel recruitment, attrition, oversampling, and survey nonresponse. RESULTSOf a total of 728 study participants, 204 (39%) were aged 18 to 34 years, 504 (61%) were women, 82 (17%) were Hispanic, and 551 (66%) were non-Hispanic White individuals. Serious psychological distress was reported by 262 participants (36%), and 214 participants (29%) also received mental health treatment from a primary care practitioner. Participants rated their mental health provider network as inadequate more frequently than their medical provider network ( 163[21%] vs 70 [10%]; odds ratio [OR], 2.69; 95% CI, 1.64-4.40; P < .001). However, among the 193 participants also receiving mental health treatment from a primary care practitioner, there was no significant difference in the ratings of mental health and medical provider networks (44 [14%] vs 18[9%]; OR, 1.55; 95% CI, 0.65-3.67; P = .32). Sixty participants (8%) reported that a mental health practitioner had left their plan's insurance network in the past 3 years. Of the 523 participants with a choice of plan, 98 (20%) considered whether a specific mental health practitioner was in network before choosing a plan. (continued) Key Points Question How do patient perceptions of mental health networks differ from perceptions of medical networks? Findings In this survey study of 728 US adults with private insurance receiving both specialty mental health and medical care, participants were signif...

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Variation In The Effectiveness Of Collaborative Care For Depression: Does It Matter Where You Get Your Care?

Cited by 23 publications

References 22 publications

Association of Organizational Culture and Climate With Variation in the Clinical Outcomes of Collaborative Care for Maternal Depression in Community Health Centers

Association of Organizational Culture and Climate With Variation in the Clinical Outcomes of Collaborative Care for Maternal Depression in Community Health Centers

The Potential for Improving the Population Health Effectiveness of Screening: A Simulation Study

Assessment of Perceptions of Mental Health vs Medical Health Plan Networks Among US Adults With Private Insurance

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